In
the American west in April 1879, a superior court rejected, thankfully,
a District Attorneys claim that a local Indian leader was not a
person "within the meaning of the law." Chief Standing Bear
of the Poncas was thus declared a person by the United States judiciary.
A month later Standing Bears brother, Big Snake, tried to leave
the reservation. The Army General in command explained to Big Snake that
the court decision granting his brother personhood applied only to Standing
Bear, not to him. Big Snake didnt understand, and was shot to death
while resisting arrest.[1]

Exactly what human qualities constitute personhood have been debated for
centuries, perhaps beginning in earnest in the sixteenth century with
the discovery of Africa and South America by Portuguese and Spanish explorers.
Their subsequent enslavement of portions of the native population led
to intense philosophical debate within the Church. One side argued that
the natives primitive culture and habits testified to their subhuman
nature, justifying their enslavement by the more culturally advanced Europeans.
The other side, the winning side in the end, stressed that primitive habits
and lack of education were not sufficiently egregious shortcomings to
disqualify the natives from the human rights due all men made in Gods
image and likeness.

This debate was the match that lit a slow fuse of thought that burned
its way through the centuries. The explosion it eventually ignited blew
slavery to bits, gave women the right to vote, and humanized factory-working
conditions, among many other accomplishments. Its supreme achievement
resulted in the universal recognition of inalienable human rights in the
Christian countries of the West, rights guaranteed in law.

Unfortunately, these rights, thought to be "self evident" and
"inalienable" by the writers of the Declaration of Independence,
are proving more difficult to define and defend only slightly more than
two centuries after their manifest nature was so famously proclaimed.
The massive legal seawall protecting human rights is eroding at its base.

The sixteenth-century debate over personhood and human dignity discussed
whether incest, lack of a written language, nakedness, human sacrifice,
child abandonment, and other primitive habits disqualified a tribe from
the human community and its corresponding legal protections. The current
debate over personhood concerns no such matters of behavior or custom.
Todays debate over dignity concerns matters of dependency.

There is a growing tendency to justify an attack on any life that exists
in a condition of radical dependency. Pro-abortionists, for example, no
longer quibble over whether preborn life is human life or not, since sophisticated
imaging technology has removed that weapon from their arsenal. Yet they
can argue that the childs state of complete dependence on its mother
excludes it from the circle of legal protection afforded autonomous persons.

The real and theoretical achievements of the sixteenth-century debate
are thus being slowly unraveled. The bonds tying personhood to human life
are being snipped cord by cord. So while a pro-abortionist will acknowledge
that the baby in the womb is a human life, that acknowledgement itself
is insufficient to guarantee that same baby the right to life. In other
words, just because someone is alive does not therefore mean that he is
a person. Only autonomous human life thus rises to the level of personhood
and its legal protections. Dependent human life, however, because of its
need for outside aids to maintain itself, does not qualify for personhood.
We are thus left with a new category of individual: the human non-person.
[2] That this sounds ridiculous does not preclude people from believing
it. Just ask Big Snake of the Poncas.
Terri Schiavos situation

Moving on from the abortion debate, the argument that human non persons
have no rights is now being applied to those on the other end of lifes
spectrum, to the elderly and terminally ill. The withdrawal of artificially
delivered nutrition and hydration from the terminally ill is the next
battleground in the struggle to defend the dignity of marginalized human
life. The circumstances of Floridian Terri Schiavo highlight the difficulty
of discerning whether certain medical procedures violate or promote human
dignity. While hard cases dont make good law, Schiavos circumstance
crystallizes all the major issues surrounding care for the terminally
ill, and provides an opportunity for priests to preach and educate our
people about human rights, the inherent dignity of all human life, and
the limits of medical treatment.

The general principles of Catholic Health Care and their practical applications
are explained in the Ethical and Religious Directives for Catholic Health
Care Services (the ERDs.) Written by the Committee on Doctrine of
the USCCB and approved by the Vatican, these Directives are normative
for Catholic Health Care in the U.S. They do not attempt the impossible
by trying to solve every conceivable health care dilemma. They do, though,
provide enough authoritative guidance to help untangle the twisted knot
of concerns which difficult end of life situations present.

In general, the Churchs position on artificial nutrition and hydration
(AN/H) is summed up in Directive # 58: "There should be a presumption
in favor of providing nutrition and hydration to all patients, including
patients who require medically assisted nutrition and hydration, as long
as this is of sufficient benefit to outweigh the burdens involved to the
patient." Leaving aside the question of benefits and burdens for
the moment, the Churchs position basically means that when a patient
can no longer swallow food and water, it is presumed that nutrition and
hydration will be delivered to that patient artificially.

There are two important exceptions to this general position, summarized
in the Introduction to Part Five of the Directives: " hydration
and nutrition are not morally obligatory when they bring no comfort to
a person who is imminently dying or when they cannot be assimilated by
a persons body."

According to the first exception, when death is imminent AN/H can be withdrawn,
provided it is giving no comfort to the patient. In such circumstances
the lack of nutrition and hydration does not cause death. The disease
process runs its course before the lack of nutrition and hydration has
the chance to adversely affect the body. The only difficulty with this
exception is that doctors skills at predicting death are overrated.
Nonetheless, to the extent that an imminent death is foreseeable, AN/H
need not be continued if it gives the patient no comfort.

The other main exception to the presumption of providing AN/H concerns
those patients suffering from stomach cancer, liver or kidney problems,
and other pathologies in the abdominal cavity. As their diseases progress
it becomes impossible for them to assimilate any nutrition or hydration
whatsoever, even if artificially delivered. In such cases nutrition and
hydration is considered futile care since it provides no nourishment.
Because it goes undigested, it can also hasten the patients death
by causing bloating and other complications.

Terri Schiavo suffered severe brain damage after cardiac arrest deprived
her brain of oxygen for ten minutes in 1990. Since that time she has never
been on a ventilator, yet she is unable to swallow food and water naturally.
Applying the principles and exceptions stated in the ERDs allows
us to come to some conclusions about her situation.

Terri Schiavos death is not imminent. She is not on a ventilator,
dialysis, or other life sustaining equipment. She is not awaiting a transplant
or other major surgery. She is not in pain. She has two parents and siblings
who love and care for her. She has access to good health care. If given
basic care and food and water her life will continue in more or less its
present state. The very fact that her present state is pretty miserable
is precisely why some think she should die.

The Church does not advocate the use of life sustaining technology at
all costs, but is against the withdrawal of technology for the express
purpose of causing death (ERDs, Intro. Part V.) Those advocating
Terri Schiavos death, including her husband, are not making their
case on medical grounds, but on Terris radical condition of dependency
and low quality of life.

As John Paul II points out in Evangelium Vitae, the meaning of
death is closely tied to the meaning of life. If a culture erodes the
meaning of life its no wonder that changes in the meaning of death
follow close behind. "When the prevailing tendency is to value life
only to the extent that it brings pleasure and well being, suffering seems
like an unbearable setback, something from which one must be freed at
all costs. Death is considered senseless if it suddenly interrupts a life
still open to a future of new and interesting experiences. But it becomes
a "rightful liberation" once life is held to be no longer meaningful
because it is filled with pain and inexorably doomed to even greater suffering."
(#64)

Because Terri Schiavo cannot speak, express much emotion, enjoy what life
has to offer, or have a life "still open to a future of new and interesting
experiences" some consider her life expendable. Terri has never said
"Put me out of my misery." It is more likely that her continued
survival bothers the consciences of those who find the emotional and practical
demands of caring for her too much. She has become a drain on their quality
of life. They, in a sense, want to put her out of their misery. This is
a far cry from the ideals of Evangelium Vitae: "True compassion
leads to sharing anothers pain; it does not kill the person whose
suffering we cannot bear." (#66)

The Terri Schiavo case presents a teaching moment for the Church, which
translates into a learning moment for our parishioners. In sum: we defend
human life in all its forms, regardless of its condition of dependency;
medical technology is to be used to sustain life unless that technologys
burdens outweigh its benefits; no one is obligated to use extraordinarily
expensive, painful, ineffective, and risky technologies to sustain life;
and AN/H is generally not considered extraordinary treatment.
A summary and talking points

Food and water is not medicine. When were hungry
we dont say "Im starving, lets go to McDonalds
and pick up some medicine."

Artificial nutrition and hydration should not be categorized
as medical treatment. Its medical care, not medical treatment.
It is on a par with the clean sheets, warm room, and bed care given
even the most terminal patients.

Artificial nutrition and hydration is not extraordinary
care. At times, though, it can be futile care.

There is a huge difference between keeping a patient
on a ventilator and artificially delivering food and water. A ventilator
is expensive, requires medical supervision, leads to infection, cannot
be used for more than a few weeks, is extremely uncomfortable, and replaces
a major body function  breathing. It is clearly extraordinary
care, unlike artificial nutrition and hydration.

The technology used to deliver artificial food and hydration
is not excessively burdensome. It is not very expensive, painful, rare,
difficult to use, or compromising of human dignity.

Not being able to swallow is not a fatal pathology.

What is the familys intention when removing food
and water? Is the intention to cause death?

"What is grandma dying of? Is she dying of her
disease process? Or is she dying of a lack of food and water?"

Does human dignity decline along with the ability to
enjoy life? Doesnt imperfect human life show in a more tangible
and powerful way our truly dependent nature before God?

Food serves the same purpose in a terminally ill person
as it does in a healthy person. It keeps him alive. If a healthy person
is denied food and water, hell die. If a sick person is denied
food and water, hell die.

The Church focuses more on the inherent value of life
than on the relative quality of life. Human life is not merely an instrumental
good, but an inherent good. It is a good of the person, not just for
the person.

[2] For a summary of the philosophical roots of the "human non person,"
see Torchia, Joseph, Postmodernism and the Persistent Vegetative State,
The National Catholic Bioethics Quarterly, summer 2002. Pg. 263.

Reverend Michael Black is a priest of the
Diocese of Rockford, ILl. He was ordained in 2000 from Mt. St. Mary's
Seminary in Emmitsburg, Maryland, with an M.A. in moral theology. He is
associate pastor at the Newman Catholic Student Center at Northern Illinois
University and teaches Health Care Ethics at St. Anthony College of Nursing
in Rockford.

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